Skin & Anti-ageing

Chemical Peel

Chemical peel for dark skin is a common dermato surgical procedure performed without any surgical instrument. Chemical peeling or chemexfoliation is the application of one or more chemical agents onto the skin resulting in dry desquamation or moist maceration followed by its exfoliation and subsequent resurfacing of the epidermis along with remodelling of collagen and elastic fibers and the deposition of glycosaminoglycans during the repair process in the dermis.

The idea behind chemical peel for skin rejuvenation is to wound the skin to bring it to the desired level, which is deep enough to cause exfoliation of the layers, while being superficial enough to allow regeneration from the appendageal structures and papillary dermis through wound healing, and promote skin rejuvenation.

Formulation used:

1. Trans-retinoic Acid Peels

These peels belong to a class of retinoids (nature and synthetic derivative of vitamin A), which are used to treat dilated pores, fine wrinkling, actinic damage and ageing, rough skin, and superficial trauma scars. They act by combining with retinol receptors and taking part in the epidermal cell regulation.

2. Combination Peels

These cause deeper penetration up to the upper reticular dermis (medium-depth peels) and are used to treat dilated pores, fine wrinkling, actinic damage and ageing, rough skin, and superficial trauma scars. The healing phase lasts for 7-10 days and these can be repeated once in 2 months.

Mechanism of Action of Peels

The outer skin layers are removed through keratolysis and kerato coagulation. In keratolysis, the peeling agents such as glycolic acid or lactic acid penetrate through the stratum corneum, break the intercellular desmosomal band and disrupt the keratinocyte cohesion. In kerato coagulation, the peeling agent such as TCA destroys the surface cells through protein denaturation and keratinocyte coagulation. Most of the very superficial peels primarily cause epidermal wounding whereas medium and deep chemical peels cause both epidermal and dermal wounding.

Stages

Coagulation and inflammation
Reepithelialization
Granulation tissue formation
Angiogenesis
Collagen and matrix remodeling

Contraindications:

Active infection (herpes labialis/bacterial)
Open cuts
Patient on photosensitive drugs
Non-cooperative patient
Unrealistic expectations

Priming

Preparing the skin for the best chemical peel for skin rejuvenation is an important part of the procedure, as it helps to certain better topical results. This can be achieved by using certain topical drugs at least 2 weeks prior to the planned day of the peel.

Sun Protection

Sun restriction with minimum sun exposure.
Use of hat, cap, scarf, umbrella, etc.
Sunscreens – Broad-spectrum sunscreen blocks both ultraviolet A(UVA) and ultraviolet B (UVB).
Patients are advised to abide by the above instructions for at least 10-15 days, prior to the peel.
Working professionals should plan the procedure ahead of a weekend because the skin peels for 2-3 days after the procedure.

Post-Peel

At home: Cold water/ice compresses or calamine lotions are given for drying and soothing. Promote epidermal desiccation and separation for the first 24-48 hours and restrict emollients.
Day 1 and 2: Skin becomes dark brown-black, desquamates completely in 5-10 days (there are early and late peelers).
Once the skin starts peeling, there is a sense of tightening and cracking. Apply emollients and keep the skin moist.
On completion, the underlying skin is erythematous. Protection from sunlight with sunscreen and moisturizers is advised for 1-2 weeks.
Use of very mild soap on face is recommended.